| NPI | 1144398280 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRELYN REED Special Projects Coordinator 800-851-8905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: NC NA) |
| Additional Taxonomies | 251S00000X |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: TN SO 09985A) | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: KY 500533) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2024-07-18 |